Impact of COVID-19 outbreak in knee arthroplasty in Chile: a cross-sectional, national registry-based analysis

Abstract

Introduction The need for beds and health personnel to treat coronavirus (COVID- 19) patients has led to the suspension of many elective sur-geries in Chile, including knee arthroplasties. This study aims to determine the incidence of knee arthroplasty in 2020, reflecting the effect of the COVID- 19 pandemic, and estimate the cost and time it would take to recover the waiting list prior to March 2020. Methods A cross- sectional study was designed. We analyzed databases from The Department of Statistics and Health Information databases from Chile for 2019 and 2020, identifying patients with surgical discharges associated with knee arthroplasty codes. We estimated the time it would take to recover the surgeries unperformed in 2020 by simulating a monthly workload increase from the 2019 baseline. The costs of knee arthroplasty paid by the National Health Fund to institutions were estimated by diagnosis-related groups. Results We found that the incidence rate of knee arthroplasty in 2020 decreased by 64% compared with 2019. The impact was higher in the public system (68%) and the National Health Found (63%). A simulated increase in knee arthroplasty productivity by 30% would allow recovering the postponed knee arthroplasty surgeries in 27 months, at a monthly cost to the public system of 318 million Chilean pesos (378 thousand US dollars). Conclusions The incidence rate of knee arthroplasty during 2020 decreased by 64%, revealing the extensive waiting line for people with knee osteoarthritis. An increase between 20- 40% in productivity compared with 2019 would allow recovering the unperformed surgeries in 20 to 41 months, at a monthly cost to the public network between 210 and 425 million Chilean pesos (250 to 506 thousand US dollars). 10.5867/medwave.2022.04.002511 https://www.medwave.cl/link.cgi/English/Reviews/Analysis/8732.act Reflections on death in the time of Covid-19 Donovan Casas Patiño The pandemic of COVID- 19 filled the world with sorrow as death was an ever- present menace everywhere. This document aims to rescue some reflective facts about death marked by a socio- historical context that revealed breaking points. These points work around three specific aspects: the agony of the dying, funeral and religious rituals, and the pilgrimage between doubt and guilt. Death in times of pandemic revealed the need to humanize and guarantee a dignified death. Likewise, the pandemic reinvented funeral rituals by globalizing them using technology and social networks. Finally, we saw that the pilgrimage preludes death and awakens the most negative feelings in the face of rejection and frustration.

Tendencias en la cirugía de artroplastía total de rodilla en Chile. ¿Cómo las estamos operando?

“…This procedure is performed with increasing frequency; in Chile, the rate per 100 thousand inhabitants constantly increased in the last decade, going from 6.4 in 2010 to 28.2 in 2019. 3 This increase only stopped because of the coronavirus disease 2019 (COVID-19) pandemic, but rates are once again rising at a fast pace. Despite this, we still do not have a Chilean registry to help us objectify and better understand fundamental aspects of surgery and how we are performing TKRs.…”

“…1,2 In Chile, the prepandemic TKR rate (2019) was of 28.2 per 100 thousand inhabitants, corresponding to more than 5 thousand procedures per year. 3 The current waiting list for TKR in Chile is the second largest in the country according to the Chilean Ministry of Health, 3 suggesting that both the TKR rate and the absolute number of procedures must increase in the short term.…”

Efficiency estimation on the use of elective surgical theaters in the Chilean public health system from 2018 to 2021

“…La pandemia por COVID-19 ha sido una causa significativa para la disminución de cirugías electivas y ocupación de pabellones. En un estudio reciente se demostró que la incidencia de artroplastia de rodilla (segunda causa de lista de espera quirúrgica) disminuyó en más de 60% durante el primer año de pandemia [12]. Sin embargo, existen varias publicaciones que guían un seguro retorno a la realización de cirugías electivas con resultados similares a la era prepandemia [13][14][15].…”

Reduced numbers of elective joint replacement procedures in Australia during the COVID‐19 pandemic, 2020–2022: a registry data analysis study

“…7 Barwon Health, Geelong, VIC. 8 South Australian Health and Medical Research Institute, Adelaide, SA. 9 7).…”

“…4 Similar reductions in elective joint replacement numbers have been reported in other countries. [6][7][8][9] As the AOANJRR records almost all joint replacement procedures in Australia, we are confident of the quality of the data underlying our projections. By estimating changes by joint replacement type, state and territory, and by hospital type (public and private), we believe our findings apply to a wide variety of settings.…”